Things to Like About the Senate Health Reform Bill (1): Redistribution

As any reader of this blog’s Law and Inequality category knows, wealth and income disparities in the US are extreme. The PPACA tries to enact some degree of distributive justice for struggling members of the lower and middle classes. Paul Krugman helpfully graphs the subsidies that will be directed to individuals to help them buy health insurance (bad copy at right; better one at the link). Maggie Mahar has been doing a good series on the “glass half full” perspective on PPACA. I agree with her summary of positive aspects of the bill:

1) “In the amended bill, insurers that hike premiums now—before reform becomes a reality—will not be allowed to sell insurance in the Exchanges;
2) “Primary care physicians will see increases in their Medicare and Medicaid reimbursements;
3) “Insurers will not be allowed to discriminate against customers suffering from ‘pre-existing conditions.’
4) “The legislation provides an additional $10 billion dollars over the next five years for community health centers. This funding will create centers in 10,000 communities.
5) “Insurers in the large group market will have to spend 85% of the premiums they spend on medical care.
6) “Medicaid expands.
7) The bill “should virtually eliminate medical bankruptcies– at least after 2014.”

As Nathan Newman puts it, “expanding coverage to thirty million folks, including 15 million more in Medicaid, plus restrictions on insurance companies and subsidies for middle class families is a good start.” We can either redistribute from the healthy to the sick, or from the richer to the poorer, and this bill will be doing some version of both.

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Frank Pasquale

Frank is Professor of Law at the University of Maryland. His research agenda focuses on challenges posed to information law by rapidly changing technology, particularly in the health care, internet, and finance industries.

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